Minimally invasive instruments and methods for preparing vertebral endplates

ABSTRACT

Instruments and methods for treating vertebral endplates are disclosed. The instrument includes one or more treatment members movable from a reduced profile position for insertion to the operative site to a deployed position for providing treatment to the vertebral endplates.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.10/422,221 filed on Apr. 24, 2003 now U.S. Pat. No. 7,674,265, which isincorporated herein by reference in its entirety.

BACKGROUND

Surgery for a patient can be painful and traumatic, particularly in theaffected area of the patient's body. For example, the dissection andretraction required to access the surgical site in the patient can causetrauma to the dissected and retracted tissue as well as to thesurrounding tissue. Tissue dissection and retraction can be required toinsert instruments to a surgical site. To accommodate insertion,sufficient dissection and/or retraction of muscle tissue, nerve tissue,vasculature tissue and other tissue must be made to allow passage of theinstrument therethrough.

Surgical instruments can include sharp elements which can cut or causetrauma to tissue in the approach to and adjacent the surgical site.Tissue dissection and retraction may be increased to avoid contactbetween the instrument and the tissue in the approach to the surgicalsite. Additionally, delicate anatomical structures may be present at ornear the surgical site. Additional instruments or other precautions maybe required to protect such tissue that limit or inhibit access to thesurgical site.

For spinal surgical procedures, preparation of an endplate for ensuingfusion can require difficult maneuvering and gesturing of surgicalinstruments, such as curettes or scrapers, to cut or penetrate the bonymaterial of the endplate. Sufficient time and effort during the surgerymust be devoted to the use such instruments to obtain the desiredresult.

There remains a need for instruments and methods that can be employedfor preparing a surgical site that minimize tissue dissection andretraction and exposure of the anatomical structures at the surgicalsite to sharp elements of the instruments. There further remains a needfor instruments and methods that can be efficiently and effectivelyemployed for preparing vertebral endplates for ensuing fusion. Thepresent invention is directed to meeting these needs, among others.

SUMMARY

A treatment instrument is provided that includes a treatment membermovable between deployed and undeployed positions. In the undeployedposition, the at least one treatment member is positionable to asurgical site without exposing the anatomical structures to sharp edgesof the treatment member. In the deployed position, the treatment memberincludes at least one treatment portion adapted to treat a vertebralendplate positioned adjacent the treatment member. The treatment of thevertebral endplate includes penetrating, crushing and/or removing bonematerial to induce bleeding to promote subsequent fusion of adjacentvertebrae in a spinal fusion procedure.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a perspective view of one embodiment of an endplate treatmentinstrument.

FIG. 2 is a perspective view of the distal portion of the instrument ofFIG. 1 in an undeployed position.

FIGS. 3 and 4 are perspective views of the distal portion of theinstrument of FIG. 1 in a deployed position.

FIG. 5 is a perspective view showing a treatment member comprising aportion of the instrument of FIG. 1.

FIG. 6 is a perspective view showing the treatment member of FIG. 5coupled to a distal portion of an actuating member of the treatmentinstrument of FIG. 1.

FIG. 7 is a perspective view showing the treatment member of FIG. 5mounted to a distal portion of a mounting member of the instrument ofFIG. 1.

FIG. 8 is a perspective view showing the distal portion of the mountingmember of FIG. 7 with the treatment member of FIG. 5 mounted thereto andoriented in a direction opposite that of the treatment member of FIG. 7.

FIG. 9 is a perspective view of the mounting member comprising a portionof the treatment instrument of FIG. 1.

FIG. 10 is a perspective view of the distal end portion of the mountingmember of FIG. 9.

FIG. 11 is a perspective view of a portion of the distal portion of anactuating member of the treatment instrument of FIG. 1.

FIG. 12 is a perspective view of a pair of linkage plates engageable tothe portion of the actuating member shown in FIG. 11.

FIG. 13 is a perspective view showing the assembly of the actuatingmember, mounting member and treatment members of the treatmentinstrument of FIG. 1 with the handle assembly removed.

FIG. 14 is a perspective view of a boss assembly at a proximal end ofthe portion of the treatment instrument shown in FIG. 13.

FIG. 15 is a perspective view of another embodiment distal end portionfor the treatment instrument of FIG. 1 with the treatment members in adeployed position.

FIG. 16 is a perspective view of the handle assembly of the treatmentinstrument of FIG. 1.

FIG. 17 is a perspective view showing the locking members of the handleassembly prior to insertion of the proximal boss members of the actuatorassembly.

FIG. 18 is a perspective view showing the locking members of the handleassembly after insertion of the proximal boss members of the actuatorassembly.

FIG. 19 is a perspective view showing the locking members of the handleassembly engaged with the proximal boss members of the actuatorassembly.

FIG. 20 is a perspective view showing the handle assembly with thelocking members engaged with the proximal boss members of the actuatorassembly.

FIG. 21 is an exploded perspective view showing handle assembly of FIG.16.

FIG. 22 is a perspective view of another embodiment endplate treatmentinstrument.

FIG. 23 is a perspective view of a proximal handle assembly providedwith the treatment instrument of FIG. 22.

DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

For the purposes of promoting an understanding of the principles of theinvention, reference will now be made to the embodiment illustrated inthe drawings and specific language will be used to describe the same. Itwill nevertheless be understood that no limitation of the scope of theinvention is thereby intended. Any such alterations and furthermodifications in the illustrated device and any such furtherapplications of the principles of the invention as illustrated thereinare contemplated as would normally occur to one skilled in the art towhich the invention relates.

Referring to FIG. 1, there is shown an endplate treatment instrument 10.Treatment instrument 10 includes a distal treatment system 12, aproximal handle assembly 16, and an actuating assembly 14 extendingtherebetween. Treatment system 12 is positionable in a spinal disc spacebetween adjacent endplates of a pair of opposing vertebrae. Treatmenttreatment system 12 includes an undeployed position, as shown in FIGS. 1and 2, for insertion through a passageway through skin and tissue to thedesired operative location. Treatment instrument 10 can be manipulatedto move treatment system 12 to a deployed position, as shown in FIGS. 3and 4, where the treatment members project outwardly to treat theadjacent vertebral endplates. When the desired endplate treatment hasbeen obtained, treatment instrument 10 can be manipulated to returntreatment system 12 to its undeployed position for repositioning in thedisc space for further treatments or for withdrawal from the patientthrough the passageway.

Treatment system 12 includes a plurality of first treatment members 26and a plurality of second treatment member 28. Treatment members 26 eachinclude a plurality of treatment portions 27 extending from one sidethereof. Treatment member 28 includes a plurality of treatment portions29 extending from one side thereof in a direction opposite treatmentportions 27. In the illustrated embodiment, treatment members 26 includetreatment portions 27 oriented in the same direction and are separatedfrom one another by a treatment member 28 that includes treatmentportions 29 oriented in the direction opposite the orientation oftreatment portions 27. Other embodiments contemplate that two or more ofthe treatment members 26 and/or treatment members 28 are positioneddirectly adjacent one another. Still other embodiments contemplate atreatment instrument 10 with treatment portions that extend in only onedirection when the treatment members are deployed.

In the illustrated embodiment, treatment portions 27, 29 provide aserrated surface along the respective treatment member 26, 28. Thetreatment portions 27, 29 include a plurality of pyramidally shapedspikes having a sharpened outer end to penetrate bone material of thevertebral endplate when deployed. Other shapes and forms are alsocontemplated for treatment portions 27, 29. For example, treatmentportions 27, 29 could include a plurality or series of elongated bladesor sharp edges that extend transversely to a longitudinal axis 11 oftreatment instrument 10. In another example, treatment portions 27, 29include one or more sharp edges that extend along the longitudinal axis11 of treatment instrument 10. Still other embodiments contemplatetreatment portions 27, 29 in the form of spikes, barbs, or teeth withsharp ends. It is also contemplated that treatment portions 27, 29 caninclude blunt ends that crush the adjacent bony structure when deployed.

In the undeployed position of FIG. 2, treatment members 26, 28 aresubstantially enclosed within a mounting portion 13 at the distal end oftreatment instrument 10. As such, mounting portion 13 prevents treatmentportions 27, 29 from contacting tissue or other anatomical structures astreatment system 12 is advanced to the desired location at the operativesite. In the deployed position of FIGS. 3 and 4, treatment portions 27,29 are moved transversely to longitudinal axis 11 and extend outwardlyfrom mounting portion 13 to engage the adjacent bony structure toprovide treatment thereto.

Treatment portions 27, 29 can at least partially penetrate, crush, orotherwise form openings in the bony material of the vertebral endplateswhen deployed. This promotes bleeding of the vertebral endplates andfacilitates bone growth and implant incorporation in interbody fusionprocedures. Treatment portions 27, 29 can be withdrawn and redeployed asneeded to provide the desired penetration and/or bleeding of theendplates. It is further contemplated that treatment instrument 10 canbe manipulated with treatment portions 27, 29 deployed to providefurther endplate treatment. For example, treatment instrument 10 can bemoved in the proximal-distal directions, laterally, and/or rotated inthe disc space in small strokes with treatment portions 27, 29 deployed.When the desired treatment has been obtained, treatment portions 27, 29can be withdrawn into mounting portion 13, allowing withdrawal oftreatment system 12 from the disc space and the patient's body withoutexposing tissue, nerves and other anatomical structures to treatmentportions 27, 29.

Referring to FIG. 5, further details regarding treatment member 26 willbe provided, it being understood that treatment member 28 can besubstantially identical thereto. Treatment member 26 includes anelongated body portion 100 extending between a proximal end 102 and adistal end 104 along longitudinal axis 101. Treatment portions 27 arespaced along longitudinal axis 101 and extend from a first side 105 ofbody portion 100. Body portion 100 includes a second side 103 extendingalong longitudinal axis 101 opposite treatment portions 27. Second side103 includes a smooth surface profile along longitudinal axis 101. Tofacilitate insertion of treatment member 26 in its undeployed positionin mounting portion 13, second side 103 can includes a curved profileadjacent distal end 104 so that distal end 104 has a blunt nose andreduced height relative to proximal end 102. First side 105 extendssubstantially parallel to longitudinal axis 101, offsetting the bluntnose at distal end 104 from longitudinal axis 101 toward first side 105.

Body portion 100 includes a proximal slot 106 orthogonally oriented tolongitudinal axis 101. Body portion 100 further includes a proximalpassage 108 and a distal passage 110. Passages 108, 110 are inclinedrelative to longitudinal axis 101 so that passage 108 includes a distalend 109 and a proximal end 111, and passage 110 includes a distal end112 and a proximal end 113. Distal ends 109, 112 are offset fromlongitudinal axis 101 and positioned adjacent treatment portions 27, andproximal ends 111, 113 are offset from longitudinal axis 101 andpositioned adjacent second side 103. Treatment member 28 similarlyincludes a body portion 100 including a proximal slot 106, a proximalpassage 108, and a distal passage 110, as shown in FIG. 8.

Referring further to FIGS. 7-10, mounting of treatment system 12 tomounting portion 13 of instrument 10 will be further discussed. Mountingportion 13 is provided at the distal end of a mounting member 15 ofactuator assembly 14, as shown in FIGS. 9 and 10. Mounting member 15includes a shaft 50 extending between a proximal end boss 52 andmounting portion 13. Mounting portion 13 includes a first flange member20 spaced from a second flange member 22. Flange members 20, 22 extenddistally from an end member 24 at the distal end of shaft 50. Flangemembers 20, 22 extend along and are offset laterally from longitudinalaxis 11, providing upper and lower openings and a distal end openingtherebetween.

Flange member 20 includes a side opening 34 extending from a distal endwall 51 of end member 24 distally along a portion of the length offlange member 20. Similarly, flange member 22 includes a side opening 36extending from distal end wall 51 of end member 24 along a portion ofthe length of flange member 22. A distal guide pin 30 extends betweenand is secured in holes 31, 35 adjacent the distal end noses 40, 44 offlange members 20, 22. A proximal guide pin 32 extends between and issecured in holes 33, 37 located about mid-length along flange members20, 22 and distally of side openings 34, 36. Flange member 20 includesdistal end nose 40 having a blunt rounded shape, and flange member 22includes distal end nose 44 having a blunt rounded shape. The bluntrounded shape facilitates insertion through tissue and into the spacebetween adjacent vertebrae.

As shown in FIGS. 6 and 11, an actuating member 60 is movably receivedin mounting member 15. Actuating member 60 includes a shaft 66 and acoupling assembly 70 at a distal end of shaft 66. Shaft 66 ispositionable in a passage 57 (FIG. 9) extending through shaft 50 ofmounting member 15 that opens at distal end wall 51 of end member 24.Coupling assembly 70 includes a drive member 71 extending transverselyfrom shaft 66. A first linkage plate 72 extends from distally from oneside of drive member 71, and a second linkage plate 74 extends distallyfrom the opposite side of drive member 71. A pin 78 can be positionedthrough proximal hole 80 (FIG. 12) of first linkage plate 72 to couplelinkage plate 72 to drive member 71. A similar pin can pass throughproximal hole 88 (FIG. 12) of linkage plate 74 to couple linkage plate74 to the other side of drive member 71. A linkage member 76 extendsbetween linkage plates 72, 74, and is spaced distally from drive member71. Linkage member 76 can be secured in distal holes 84, 86 of linkageplates 72, 74.

When assembled, treatment members 26, 28 are coupled to couplingassembly 70 and positioned between and movable relative to flangemembers 20, 22 by movement of actuating member 60. Treatment members 26,28 are movably mounted to flange members 20, 22 with distal guide pin 30extending through distal passages 110, and proximal guide pin 32extending through proximal passages 108. Linkage member 76 of couplingassembly 70 extends through proximal slots 106, and linkage plates 72,74 are received in respective ones of the side openings 34, 36. Drivemember 71 of coupling assembly 70 is positioned distally of distal endwall 51 of end member 24 between flange members 20, 22. Drive member 71is larger than the opening of passage 57 at the distal end of shaft 50,and can contact distal end wall 51 to limit proximal movement ofcoupling assembly 70 and thus actuating member 60 relative to mountingmember 15.

When treatment members 26, 28 are in their undeployed position, proximalmember 71 is adjacent end wall 51, guide pin 32 is located adjacentdistal ends 112 of distal passages 110 and distal ends 109 of proximalpassages 108. Linkage member 76 is located adjacent the upper end ofproximal slots 106. In the undeployed position, treatment members 26, 28are retracted so that treatment portions 27 are recessed at or below theupper ends 41, 45 of flange members 20, 22, and treatment portions 29are recessed at or below the lower ends 43, 46 of flange members 20, 22,as shown in FIG. 2. In the undeployed position, the reduced heightdistal ends 104 of treatment members 26, 28 are substantially alignedwith the rounded distal end noses of 40, 44 of flange members 20, 22, asshown in FIG. 2. This provides treatment system 12 with a taperedleading end having smooth surface profile, facilitating insertion into aspinal disc space. It is contemplated that flange members 20, 22 canfacilitate recapitulation of a collapsed disc space as it is insertedtherein.

When deployed, actuating member 60 is moved distally relative tomounting member 15, thereby advancing coupling assembly 70 distallybetween flange members 20, 22. This distal movement advances treatmentmembers 26, 28 along guide pins 30, 32 until guide pin 32 is locatedadjacent proximal ends 113 of distal passages 110 and proximal ends 111of proximal passages 108. The inclination of passages 108, 110 relativeto longitudinal axis 101 of treatment members 26, 28 causes treatmentmembers 26, 28 to move upwardly and downwardly, respectively, advancingtreatment portions 27, 29 beyond the upper ends 41, 45 and lower ends43, 46 of flange members 20, 22. Linkage plates 72, 74 aresimultaneously advanced distally in side openings 34, 36.

As shown in FIGS. 3 and 4, treatment members 26 are moved upwardlythrough the upper opening between flange members 20, 22 when moving tothe deployed position, and treatment members 28 are moved downwardlythrough the lower opening between flange members 20, 22 when moving tothe deployed position. Treatment members 26, 28 also move distallyrelative to flange members 20, 22 so that distal ends 104 extenddistally past distal ends 40, 44 of flange members 20, 22 through thedistal opening between flange members 20, 22. It is contemplated thattreatment members 26, 28 move parallel to longitudinal axis 11 oftreatment instrument 10 so that the entire length of treatment members26, 28 contacts the adjacent vertebral endplate to provide treatmentthereto when deployed.

The mounting arrangement between mounting portion 13 and treatmentmembers 26, 28 facilitates the application of sufficient force totreatment members 26, 28 so that treatment portions 27, 29 can penetrateand/or crush the adjacent bony structure when deployed. Guide pins 30,32 provide multiple support locations in the passages 110, 108 oftreatment members 26, 28 to maintain parallel movement of the treatmentmembers 26, 28 relative to longitudinal axis 11 throughout the range ofmotion between deployed and undeployed positions.

Distal movement of actuating member 60 in mounting member 15 can belimited by any one or combination of contact of the guide pins 30, 32with the proximal ends of passages 110, 108; contact of linkage member76 with the end of slot 106 opposite the respective treatment portions27, 29; contact of linkage plates 72, 74 with the distal ends of sideopening 34, 36; with an arrangement between the proximal ends ofmounting member 15 and actuating member 60; or with the handle assembly16.

Referring now to FIGS. 13-14, the proximal ends of actuating assembly 14will be discussed. Actuating assembly 14 includes mounting member 15 andactuating member 60 movably received in passage 57 (FIG. 9) extendingthrough shaft 50 of mounting member 15. Mounting member 15 includes aboss 52 at a proximal end of shaft 50, and actuating member 60 includesa boss 62 at a proximal end of shaft 66. Boss 52 includes a proximalextension 54 extending partially around passage 57, and boss 62 includesa distal extension 64 extending partially around shaft 66. Distalextension 64 is movable along proximal extension 54. Proximal movementof shaft 66 relative to shaft 50 can be limited by, for example, contactof proximal member 71 with distal end wall 51, to maintain extensions54, 64 in an overlapping arrangement. Distal movement of shaft 66relative to shaft 50 can be limited by, for example, contact of boss 62with boss 52.

Extensions 54, 64 contact one another to resist inner shaft 66 fromrotating within passage 57. Proximal boss 62 can include a first notch68 formed in a first side thereof and a second opposing notch (notshown) in the opposite side. Proximal boss 52 can include a first notch58 formed in a first side thereof and a second opposing notch (notshown) in the opposite side. As discussed further below, notches 58, 68facilitate attachment of handle assembly 16 to bosses 52, 62.

Referring to FIG. 15, another embodiment treatment system 120 includestreatment members 26 with treatment portions 27 projecting upwardly fromflange members 20, 22 and treatment members 28 with treatment portions29 projecting downwardly from flange members 20, 22. In the illustratedembodiment, four treatment members 26, 28 are provided and alternatewith one another so that every other one of the treatment membersextends upwardly or downwardly. By providing fewer treatment members 26,28, the width between flange members 20, 22 can be reduced facilitatingthe use of treatment instrument 10 in minimally invasive surgicaltechniques. Other embodiments contemplate other numbers of treatmentmembers, including one treatment member up to ten or more treatmentmembers. In embodiments with multiple treatment members, the treatmentportions of adjacent treatment members can extend in opposite directionsas shown. It is further contemplated that two or more adjacent treatmentmembers can include treatment portions extending in the same direction.

It is contemplated that the vertebral endplate treatment instrumentsdiscussed herein can be used in minimally invasive surgical techniqueswhere the disc space is accessed through a micro-incision, a sleeve, orone or more retractors that provide a protected passageway to the discspace. The treatment instruments also have application in open surgicaltechniques where skin and tissue are incised and retracted to expose thesurgical site. The treatment instruments can be useful in posteriorapproaches to a spinal disc space where tissue, nerves, and theposterior vertebral elements hinder access to the disc space.Applications in other approaches, including anterior, anterior-oblique,lateral, and postero-lateral approaches are also contemplate. Thetreatment instruments also have application in procedures that accessany region of the spine, including the cervical, thoracic, lumbar andsacral regions.

In FIG. 16, handle assembly 16 is shown removed from the distal portionof treatment instrument 10 shown in FIG. 13. Handle assembly 16 includesa proximal knob 140 and a body 144 extending from knob 140. Handleassembly 16 further includes a fixed shaft 146 coupled to body 144, anda movable shaft 148 coupled to knob 140. Actuating member 60 is coupledto movable shaft 148 with locking member 150, and mounting member 15 iscoupled to fixed shaft 146 with locking member 152. Locking members 150,152 releasably engage notches 68, 58, respectively, to secure the distalportion of instrument 10 to handle assembly 16.

Referring further to FIGS. 17-18, there is shown locking members 150,152 without the remaining portions of handle assembly 16. In FIG. 17,locking members 150, 152 are in their unlocked position so thatcylindrical passage portions 154, 158 are aligned with bosses 62, 52.Bosses 62, 52 are positionable through passage portions 154, 158 toalign notches 68 with non-cylindrical passage portion 156 of lockingmember 150 and to align notches 58 with non-cylindrical passage portion160 of locking member 152, as shown in FIG. 18. Locking member 150 canthen be moved so that passage portion 156 engages notches 68, andpassage portion 160 engages notches 58, as shown in FIGS. 19 and 20. Inthis engaged position, boss 62 is engaged with movable shaft 148, andboss 52 is engaged with fixed shaft 146.

Locking member 150 includes a slotted receptacle 162 that receives a pin(not shown) coupled to movable shaft 148 to movably secure lockingmember 150 thereto. Similarly, locking member 152 includes a slottedreceptacle 164 to receive a pin 166 coupled to fixed shaft 146 tomovably secure locking member 150 thereto. In the locked position oflocking members 150, 152 shown in FIG. 20, one end of each of thelocking members 150, 152 aligns with an outer surface of thecorresponding shaft 146, 148 while the other end protrudes outwardlytherefrom. The other ends of locking members 150, 152 can be depressedto align passage portions 154, 158 with bosses 62, 52 to uncouple handleassembly 16 and allow its removal therefrom.

Referring to FIG. 21, knob 140 is rotatable relative to body 144 in afirst direction such as, for example, counterclockwise, to axially anddistally advance movable shaft 148 within fixed shaft 146. For example,movable shaft 148 can be provided with a threaded proximal end 168 thatis threadingly engaged with knob 140 in body 144. The non-rotating,distal movement of movable shaft 148 distally advances actuating member60 in mounting member 15, thus deploying treatment members 26, 28 frommounting portion 13. Rotation of knob 140 in the opposite directionmoves movable shaft 148 and actuating member 60 proximally in theopposite direction to undeploy treatment members 26, 28 whilemaintaining mounting member 15 stationary. Fixed shaft 146 is engagedwith body 144 with proximal extensions 170 that extend along threadedproximal end 168.

A torque handle 142 can be provided that extends laterally from fixedshaft 146. Torque handle 142 can be grasped by the surgeon to facilitateinsertion and withdrawal of the distal end of instrument 10 from theoperative site. Torque handle 142 can also assist in moving instrument10 proximally, distally, and/or rotationally about axis 11 withtreatment members 26, 28 in the deployed condition to provide furthertreatment of the endplates.

FIGS. 22-23 show another embodiment treatment instrument 210 which canbe identical to treatment instrument 10 above except for handle assembly216. Handle assembly 216 employs a handle and lever arrangement to moveactuating member 60 relative to mounting member 15. Handle assembly 216includes a fixed handle 218 and a movable handle 220. Movable handle 220can be coupled to a linkage 228 proximal of housing 224. Linkage 228 iscoupled to the proximal end of actuating member 60 by, for example, alocking member 226 releasably engaged with notch 68 in proximal boss 62in the manner discussed above with respect to handle assembly 16. Fixedhandle 218 is fixedly coupled to housing 224, which is fixedly coupledto the proximal end of mounting member 15. A leaf spring 222 can beprovided between handles 218, 220 to bias movable handle 220 away fromfixed handle 218, and thus normally positioning treatment members 26, 28to the undeployed position for insertion and withdrawal from theoperative site. Handle 220 is moved toward handle 218 to distallyadvance actuating member 60 relative to mounting member 15 and therebydeploy treatment member 26, 28 from mounting portion 13.

While the invention has been illustrated and described in detail in thedrawings and foregoing description, the same is to be considered asillustrative and not restrictive in character. All changes andmodifications that come within the spirit of the invention are desiredto be protected.

What is claimed is:
 1. A vertebral endplate treatment instrument,comprising: a handle assembly; an actuating assembly extending distallyfrom said handle assembly along a longitudinal axis; a treatment systemat a distal end of said actuating assembly, said treatment systemincluding at least one treatment member movable with said actuatingassembly from an undeployed position to a deployed position, whereinsaid at least one treatment member includes a plurality of treatmentportions adapted to at least partially penetrate a vertebral endplate insaid deployed position, wherein said at least one treatment memberfurther includes a body portion extending along a longitudinal axisbetween a proximal end and a distal end and said plurality of treatmentportions extend along one side of said body portion between saidproximal end and said distal end, wherein said body portion includes: adistal passage oriented obliquely to said longitudinal axis of said bodyportion and a proximal passage oriented obliquely to said longitudinalaxis of said body portion so that said distal passage includes a distalend offset from said longitudinal axis toward said plurality oftreatment portions and a proximal end offset from said longitudinal axistoward a side of said body opposite said treatment portions and saidthat said proximal passage includes a distal end offset from saidlongitudinal axis toward said plurality of treatment portions and aproximal end offset from said longitudinal axis toward a side of saidbody opposite said treatment portions; and a slot through said bodyportion that is orthogonally oriented to said longitudinal axis of saidbody portion and located proximally of said proximal passage; whereinsaid actuating assembly includes guide members extending throughrespective ones of said proximal and distal passages and a linkagemember extending through said slot, said guide members and said linkagemember couple said at least one treatment member to said actuatingsystem and act upon said at least one treatment member with actuation ofsaid actuating system to move said at least one treatment member betweensaid undeployed and deployed positions.
 2. The instrument of claim 1,wherein said plurality of treatment portions are in the form of spikeshaving an outwardly extending pointed end.
 3. The instrument of claim 1,wherein said distal end of said body portion includes a tapered nose. 4.The instrument of claim 1, wherein said at least one treatment membercomprises a second treatment member movable simultaneously therewithfrom a deployed position to an undeployed position with said actuatingsystem, said second treatment member including a plurality of treatmentportions extending in a direction opposite said plurality of treatmentportions of said at least one member, said plurality of treatmentportions being adapted to at least partially penetrate an adjacentvertebral endplate in said deployed position.
 5. The instrument of claim4, wherein each of said treatment members includes: a body portionextending along a longitudinal axis between a proximal end and a distalend; and said plurality of treatment portions extend along one side ofsaid body portion between said proximal end and said distal end.
 6. Theinstrument of claim 4, wherein for each of said treatment members: saiddistal end of said body portion includes a tapered nose, wherein in saidundeployed position said noses are substantially aligned with oneanother along a longitudinal axis of the treatment instrument and insaid deployed position each of said noses are advanced distally andoffset from one another on opposite sides of the longitudinal axis ofthe treatment instrument.
 7. The instrument of claim 4, wherein each ofsaid treatment members moves parallel to the longitudinal axis betweenthe undeployed and deployed positions.
 8. The instrument of claim 1,wherein said at least one treatment member moves parallel to thelongitudinal axis between the undeployed and deployed positions.
 9. Theinstrument of claim 1, wherein said at least one treatment memberincludes a plurality of treatment members positioned in side-by-siderelation, each of which include a plurality of treatment portions,wherein said treatment portions of adjacent ones of said treatmentmembers extend in opposite directions.
 10. The instrument of claim 1,wherein said actuating assembly includes a mounting portion at a distalend thereof, and said mounting portion includes a first flange memberand a second flange member spaced from said first flange member, saidfirst and second flange members defining an upper opening and a loweropening therebetween, said at least one treatment member beingpositioned between said first and second flange members, wherein in saiddeployed position said plurality of treatment portions extend throughone of said upper and lower openings.
 11. The instrument of claim 10,wherein said first and second flange members further define a distalopening and in said deployed position said at least one treatment memberextend through said distal opening.
 12. The instrument of claim 10,wherein in said undeployed position said at least one treatment memberis positioned entirely between said first and second flange members. 13.A vertebral endplate treatment instrument, comprising: a handleassembly; an actuating assembly extending distally from said handleassembly along a longitudinal axis; and a treatment system at a distalend of said actuating assembly, said treatment system including at leasttwo treatment members each extending in parallel relation to one anotherand parallel to said longitudinal axis of said actuating assembly,wherein each of said at least two treatment members is movable with saidactuating assembly from an undeployed position to a deployed positionwhile maintaining said generally parallel relation of said at least twotreatment members with one another and maintaining said parallelrelation with said longitudinal axis of said actuating assembly, whereinsaid at least two treatment members each include a body portionextending between a proximal end and a distal end comprising: at leastone passage extending through said body portion that is orientedobliquely to said longitudinal axis; and a slot extending through saidbody portion that is orthogonally oriented to said longitudinal axis;wherein a guide member extends through said proximal passages and alinkage member extending through said slots, said guide member and saidlinkage member couple said at least two treatment members to saidactuating system and act upon said at least two treatment members withactuation of said actuating system to move said at least two treatmentmembers between said undeployed and deployed positions.
 14. Theinstrument of claim 13, wherein each of said at least two treatmentmembers includes a plurality of treatment portions adapted to at leastpartially penetrate a vertebral endplate in said deployed position. 15.The instrument of claim 13, wherein each of said at least two treatmentmembers includes: a body portion extending along said longitudinal axisbetween a proximal end and a distal end of said body portion; aplurality of treatment portions extending along one side of said bodyportion between said proximal end and said distal end; said body portionincludes a distal passage oriented transversely to said longitudinalaxis and a proximal passage oriented transversely to said longitudinalaxis; said actuating member includes a shaft and a coupling assembly ata distal end of said shaft in said mounting portion, said couplingassembly including a linkage member; said mounting member includes ashaft defining a passage for receiving said actuating member, saidmounting portion including: a first flange member and a second flangemember spaced from said first flange member, said at least two treatmentmembers being positioned between said first and second flange members; adistal guide member extending between said first and second flangemembers; and a proximal guide member extending between said first andsecond flange members, wherein said distal guide member extends throughsaid distal passage of said body portion, said proximal guide memberextends through said proximal passage of said body portion, and saidlinkage member extends through said proximal slot of said body portion.16. The instrument of claim 15, wherein said coupling assembly includesa drive member and a pair of linkage plates extending distally fromopposite sides of said drive member, said linkage member extendingbetween said linkage plates distally of said drive member.
 17. A methodfor treating a vertebral endplate, comprising: accessing a spinal discspace between adjacent vertebrae; providing the vertebral treatmentinstrument of claim 1; positioning the treatment system adjacent atleast one endplate of the adjacent vertebrae; deploying the treatmentsystem in the spinal disc space, wherein the treatment system includes aplurality of treatment portions for penetrating the adjacent vertebralendplate when deployed; and inducing bleeding of the adjacent vertebralendplate with the treatment system.
 18. The method of claim 17, whereinsaid treatment portions include a plurality of spikes with outer endsadapted to pierce the vertebral endplate.
 19. The method of claim 17,further comprising fusing the adjacent vertebrae with bone growthmaterial in the disc space.
 20. The method of claim 17, wherein thespinal disc space is accessed in a minimally invasive surgical approach.